Second botulism death unrelated to ‘extremely rare’ nacho cheese botulism

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The Valley Oak Food and Fuel gas station in Walnut Grove was the site of a botulism outbreak earlier this month. State health officials confirmed that Type A botulism toxin was found in an opened bag in the store. (Sammy Caiola/Sacramento Bee)

SACRAMENTO — The country’s foremost researchers on botulism in dairy products are calling the recent outbreak at a gas station in Walnut Grove a “perfect storm” of circumstances that left one dead and nine sickened.

“Botulism in cheese products, including processed cheese, is extremely rare,” said Eric Johnson, professor in the department of bacteriology at the Botulinum Toxins Laboratory at the University of Wisconsin. “Outbreaks of botulism in commercially processed cheese during the past 50 years is extremely rare and can be counted on the fingers of one hand.”

Although extremely rare, Northern California has seen two deaths from foodborne botulism in the last few months. Within the last month, Napa County has had one death from botulism related to canned goods, according to county health officials.

Lethal Toxin

Although it is sometimes used in medicine to treat muscle spasms or in cosmetics to treat frown lines, the botulism neurotoxin is one of the most potent and lethal substances in the world. The substance, which can fatally paralyze victims, is so dangerous that it is listed as a Category A bioterrorism agent by the CDC.

Less than one-millionth of a gram is enough to kill the average adult.

The Type A strain of botulinum toxin found in the nacho cheese is the same type that is cultivated for biological weapons.

There is no antidote for botulism intoxication, but early use of an antitoxin can lessen the effects of the paralysis. Although symptoms can take anywhere between six hours and 10 days to appear. Ideally, the antitoxin should be administered within hours of eating the food to prevent the onset of paralysis.

Since 1950, the United States has seen three instances of human botulism outbreaks due to dairy products. In all, 46 people were affected and two died. The most recent was in 1993 when a commercially canned cheese sauce was contaminated after it left the factory, sickening eight people and killing one.

“We want to remind people to properly store canned goods they purchase, and if they are canning themselves to follow recommended home canning and preserving procedures so you can ensure as best as possible the safety of your canned goods,” said Cara Mae Wooledge, public health education specialist for Napa County Public Health.

Before these incidents, there had only been one death from foodborne botulism in the state of California in the past two decades, according to CDC data.

On April 28, the Los Angeles County Public Health Department issued a warning to residents about a deer antler tea product after one confirmed and one suspected case of botulism. The tea was recalled.

The California Department of Public Health has said that an open 5-pound bag of Gehl’s Jalapeno Cheese Sauce confiscated from the Valley Oak Food and Fuel station tested positive for the botulism toxin.

Gehl Foods’ CEO Eric Beringause released a statement saying that “Gehl’s facilities remain safe for food production and all of our food samples continue to test negative for any contaminants. There is no recall of Gehl’s nacho cheese product.”

Johnson, along with his colleague Kathleen Glass, have devoted their lives to studying how to prevent botulism from growing in cheese. Glass, the associate director of the Food Research Institute, received her doctorate in the topic and has co-authored numerous papers on the subject with Johnson. Both have spent decades working out the right combinations that prevent the bacteria, Clostridium Botulinum, from surviving or growing in cheese.

Gehl’s cheese is in liquid form and is not pasteurized, but undergoes an “aseptic process,” which kills bacteria. The cheese has a shelf life of 12 months, but must be kept above 140 degrees after opening and the dispenser must remain plugged in.

“If the package is unopened, it is basically sterile. If it’s refrigerated, (the bacteria) can’t grow. If it’s kept above 140 Fahrenheit, it can’t grow,” Glass said. “This was just an alignment of the planets that must have recontaminated it and held it at the right temperature for a long time for it to grow. … It’s really the perfect storm.”

Botulism is found everywhere, but sickness from the toxin the bacteria produces is rare and mostly affects infants. Botulism among adults is even rarer. Foodborne botulism is rarer still.

Due to the rarity, there is a chance that the descending paralysis is misdiagnosed as Guillain-Barré syndrome, a stroke or other medical conditions that lead to muscle weakness.

One recent victim, Lavinia Kelly, was initially discharged from the hospital and had to return the next day as her symptoms worsened. Family members of Martin Galindo-Larios Jr., of Rio Vista, wrote on a GoFundMe page that there was a “lack of care at the previous hospital” and that his illness spread, eventually leading to Galindo-Larios being declared clinically brain-dead.

Yolo County issued a public health warning, saying that there may have been possible misdiagnoses of botulism given the recent norovirus outbreak that sent nearly a thousand students and school staff at multiple schools home sick. Health officials urge anyone with symptoms such as blurred or double vision, difficulty swallowing or speaking, or facial weakness to call Yolo County Infectious Disease at 530-666-8670 or after hours at 530-321-3620.

Aaron Davis reports on East Contra Costa County for the Bay Area News Group. He has worked for papers throughout the Seacoast of New Hampshire, as well as in Queens, New York and in Amarillo, Texas. Send tips to 408-859-5105 or to aarondavis@bayareanewsgroup.com.